Multiple sclerosis and pregnancy

Abstract

Epilepsy and multiple sclerosis (MS) are the 2 most common neurologic disorders affecting women of childbearing age. As many as 25,000 women with epilepsy (WWE) give birth annually.1 While similar national estimates for birth prevalence in women with MS (WWMS) are not available, with the average age at MS onset at 30 years, around one fifth of women with MS will bear children after onset of the disease.2 This presents an important opportunity for neurologists caring for these women to provide transparent, evidence-based information to both inquiring patients and to referring physicians who may be providing concurrent care. In planning pregnancy, these women will want to know both the impact of a potential pregnancy on the neurologic disease (e.g., seizure frequency, MS exacerbation), as well as the impact of the disease on pregnancy and birth outcomes. For epilepsy, an extensive amount of useful information on both issues was recently published in a series of evidence-based guidelines in Neurology ®.3,4 There is also substantial information on the short-term impact of pregnancy on MS: the exacerbation rate is reduced during the second and third trimester and increased during the first 3 months following delivery, resulting in no net change in relapse rates over the entire pregnancy year (9 months gestation + 3 months postpartum).5 In addition, exclusive breastfeeding has been recently reported to dramatically reduce the postpartum …